Workflow. Quality Assurance. Workflow. Hologic 3D Tomosynthesis Connectivity Information OBJECTIVES 3/31/2015

Transcription

1 Recognize the current 2D connectivity workflow Gain insight into tomosynthesis connectivity Understand the anatomy of a tomosynthesis image State the variety of tomosynthesis image sizes Indentify the hardware & software requirements Hologic 3D Tomosynthesis Connectivity Information Hologic Proprietary Information for Training Purposes Only OBJECTIVES Quality Assurance Workflow The relationship of activities within a project from start to finish. All-encompassing management program used to ensure excellence in healthcare through the systematic collection and evaluation of data. Patient scheduling, management techniques, departmental policies and procedures, technical effectiveness and efficiency, in -service education and image interpretation Work Flow Workflow is the automation of a process, in whole or part, during which documents, information or work items are passed from one participant to another for action, according to a set of procedural rules. Workflow Understanding workflow is the process of analyzing individual steps that occur during a single event, such as the performance of a Mammography exam. The primary focus of workflow optimization within the imaging department is automation and task consolidation. A number of other factors should be considered including the workload, availability of human resources, and the specific technologies being employed. 1

2 Work Flow Current IT solutions in radiology are predominantly data-focused and do not provide sufficient support for workflow. A five step workflow process for building solutions Work flow is identifying people, systems, and interactions that are involved in producing a specific task or outcome. Phase 1: Inform Create an accurate before picture Define key metrics Define enterprise goals in specific terms Define buzzword free strategies to fulfill the goals Phase 2: Discover Meet with users to reconcile differences between enterprise goals and the users expectations Develop an understanding of enterprise infrastructure and users Meet again with the users to calibrate the views and information Provide recommendations that reconcile any differences in enterprise goals and users expectations Phase 3: Plan Build a tactical plan of action to meet enterprise goals while satisfying users needs Specify details by answering questions like: How are we going to solve problems that the enterprise and the users have? How do we give our clients needed tools? How do we lay out the capabilities? What is the architecture? What are the visual representations with which the users will interact? 2

3 Phase 3: Plan, cont. Create a project schedule specifying all the client s key objectives Schedule a review of key objectives as each milestone is met Continually redefine plan based on client and user feedback Create a working draft of system architecture Create a technical prototype Search for areas of risk or circumstances that will make the system perform poorly Phase 4: Build Build, and test the solution Create test and maintenance plans to sustain the program Build human factors team to consult with the client Select test users from critical groups with differing job functions Deploy the solution Phase 5: Evaluate Revisit the goals and metrics set in Phase 1, asking: Did we achieve the enterprise goals? Did we meet the users expectations? Did we add the value we hoped to add? Actively seek feedback to satisfaction Your should master systems thinking if you wish to manage change effectively. Systems thinking "focuses on the whole, not the parts, of a complex system. It concentrates on the interfaces and boundaries of components, on their connections and arrangement, on the potential for holistic systems to achieve results that are greater than the sum of the parts. Mastering systems thinking means overcoming the major obstacles to building the process managed enterprise for every business process is a whole system.". 3

4 Welcome to Alice in Workflow Land Alice Performs BSE & Finds a Lump Step 1 Go to Doctor Twiddle Dee Doctor Orders Mammogram Study Step 2 Order Placed in RIS 4

5 Hospital System Sends Order to RIS & PACS Step 3 Copy of Patient Info, Exam Info including Accession # Alice Goes to Radiology, Where they check for exam using Modality Work list Query to PACS Step 4 PACS send Patient and Exam information, including accession # Alice has Mammo, Radiology sends study to PACS via DICOM Store Alice shows up on Radiologist's Work list Step 6 Radiologist's workstation queries by selected parameters Step 5 PACS send Patient and Exam information, including accession # & Images Radiologist Reads Study Step 7 Radiologist's workstation receives Patient and Study information from PACS, including accession #, sets status of exam to Read Radiologist Dictates Study Step 8 Radiologist's Report Gets Produced by varying methods and makes it back to the RIS, by various methods 5

6 RIS Stores Report Step 9 Report matches up with correct order via accession # Radiology Sends Report to PACS Step 10 PACS matches up with right study via accession # PACS is HAPPY! Finished tracking the study Dr. T. Dee asks to see Alice's results Exam Loop stops tracking PACS checks authorization and gives results Dr. T. Dun asks to see Alice's results Digital Basic workflow PACS checks authorization and denies access at least until authorization is granted 6

7 Referring Clinician 1. Physician order entry on hospital information system 9. Report available on hospital information system. Ideal Workflow Radiologist 7. Review images & reports 8. Dictate report using voice recognition technology Tomosynthesis: Current 2D Connectivity Workflow Image Processing Workflow Mammography System DICOM Modality Work list PACS CAD Softcopy Workstation Transporter Aide 2. Transport patient to department 6. Transport patient back Technologist 3. Technologist chooses patient from MWL 4. Obtain images 5. Edit & check images for quality Mammography System RT Workstation Mammography Printer What is different with 3D Tomosynthesis workflow? Not a whole lot. Really. Tomosynthesis image data is a heck of a lot bigger! What is different with 3D Tomosynthesis workflow? Currently, a Hologic SecurView Workstation is required for display of tomosynthesis images. Tomosynthesis Workflow Two Types of 3D Tomosynthesis Image Data RIS PACS DICOM Modality Work list PACS Hologic Proprietary Secondary Capture Object It is what is used today. DICOM Breast Tomosynthesis Object Actually, the real terminology is: DICOM Breast Tomosynthesis Image IOD Information Object Definition Mammography Systems Softcopy Workstation The DICOM Breast Tomosynthesis Image Object is just another way of packaging the tomosynthesis reconstructed slice data CAD This is what all will use eventually Mammography Printer 7

8 Hologic Proprietary Secondary Capture Object Selected by Hologic, the first to meet the challenge as to the Tomosynthesis data format. There was no standard available at the time Only the SecurView workstation and Dimensions Mammography system can display this image data Data is already compressed for storage and network speed efficiencies Hologic Proprietary Secondary Capture Object Most PACS companies can support the storage of the Secondary Capture object But Not the display at this time If sent to PACS, the PACS workstation is only able to display the middle reconstructed slice For example, if there are 50 slices, slice number 25 will be displayed. This is not for diagnostic use. So what can you do.. A Typical Combo Study (2D + 3D under one compression) You can send 2D and chose a slice to send to surgeon that best shows the pathology Export as a TIF image Must be a DICOM image for interpretation Who ever gets the image must be able to open it Outside facilities cannot view the cine images DICOM objects Reconstructed Slices Digital Mammo For Presentation 2D Digital Mammo For Processing To PACS To Softcopy Workstation CAD 2D Important Information about the DICOM Breast Tomosynthesis Object This is not proprietary, so any vendor s station that supports the DICOM Breast Tomo Object can display this image data Hologic is working with PACS companies today for support of the DICOM Breast Tomo Object PACS companies are in the very early stages of support for the DICOM Breast Tomo Object Hologic and PACS Vendors DICOM Breast Tomo Object Implementation Hologic is working with other vendors in the DICOM community and has provided sample DICOM Breast Tomosynthesis images to any PACS vendor that has requested them Hologic is providing answers to technical questions regarding data, transmission, and application PACS companies are working with their customers on requirements and feature design 8

9 Hologic and PACS Vendors DICOM Breast Tomo Object Implementation Advanced PACS Hologic states that by early 2012 other PACS vendors will be able to use but not as of yet Some PACS vendors are use to large files and multiple studies Images are compressed at the AWS-how they are stored and displayed at RWS are Hologic specific-they have recommendations for speed of PACS and storage regarding how many studies are stored at RAD RWS Advanced PACS Hologic Digital Mammography File Sizes Typical 4 View Study, Left and Right Breasts 4 View Study 2D Hologic Secondary Capture Tomo Object Uncompressed 88 MB N/A(this is always compressed) DICOM Breast Tomo Object 1.2GB Compressed (lossless) 22 MB 136 MB 320 MB Total Combo File Size 158 MB 324 MB Caution: Notes: 1. The Hologic Secondary Capture Tomo Object is already compressed and cannot be compressed further. 2. Compressing image data always relies on the ability to decompress the data (PACS, SecurView). 9

10 In the Digital World: Things never stay the same Hologic 3D Tomosynthesis Connectivity Information The Mario Brothers game you purchase today, cannot possibly play in your original Nintendo console. The software has evolved, becoming bigger, better and faster, with many more features. More powerful hardware is needed to efficiently run the software. Thank you! 10